SARASOTA, FL – With the fall football season underway, shoulder injuries are on the rise among athletes of all ages. Therefore, it’s important to know how to handle shoulder separations, dislocations and fractures that occur in contact sports like football and lacrosse.
Shoulder separations are one of the most common injuries in football, and may occur when a player is thrown to the ground into the shoulder by a tackler. Shoulder damage can also occur in non-athletes who lose their balance and fall or are injured in an automobile accident.
A shoulder separation occurs when the ligaments that stabilize the acromioclavicular (AC) joint are fully or partially torn. As a result, the wing bone above the arm moves away from the collarbone or clavicle creating a bump or bulge on the top of the shoulder.
If an injury occurs on the playing field, an athletic trainer or team doctor can assess the nature and severity of the shoulder problem. If the main shoulder joint is dislocated – another common injury in contact sports – the athletic professional may be able to place the major joint back into place right on the sideline, resulting in an immediate reduction in pain. However, a trip to the emergency room is still needed to perform x-rays and assess the placement of the joint and to look for any other injuries or fractures that can be associated with these injuries.
Routine shoulder x-rays should be taken in all cases of a violent shoulder injury. In general, the recommended immediate treatment is to put the arm in a sling to take the weight off the injured shoulder, put ice on the shoulder to reduce swelling and take over-the-counter pain medications if needed.
Fortunately, approximately 90 percent of shoulder separations can be treated without surgery. In some cases, a patient may need to wear a sling for several weeks to reduce the pressure on the AC joint until the ligaments can fully recover. Once the patient has recovered, physical therapy treatments can help restore the shoulder’s strength, flexibility and range of motion without placing undue stress on the ligaments. In the case of a major shoulder dislocation, if the initial treatment should fail, surgical stabilization of the joint may be necessary. This can often be performed arthroscopically.
Regarding more serious cases involving the AC joint, surgery may be needed to reconstruct the ligaments, and bring the bones more closely into alignment. It may also be needed if pain in the shoulder becomes a chronic problem or if there is a visible deformity. Shoulder separation surgery can also reduce the risk of longer-term problems, such as arthritis in the AC joint. Most patients have good outcomes from shoulder separation surgery. However, it’s important to allow several months for recovery, including a personalized rehabilitation program. After that, an athlete can usually return to playing sports. However, a shoulder that has previously been injured may be more susceptible to damage in the future. Therefore, it’s important to talk with your doctor before making a decision to return to a contact sport.
Dr. Sforza, who focuses his practice on problems involving the shoulder, arm, elbow, forearm, wrist and hand, is director of sports medicine for the new Premier Sports Campus in Lakewood Ranch and is the official orthopedic surgeon and hand surgeon to the Sarasota Orchestra. He also coaches youth lacrosse teams and is a special consultant for the !MG Academies and the Nick Bollettieri Tennis Academy and serves as an assistant clinical professor at the Florida State University College of Medicine, Sarasota Campus.